YMCA Application

SCHOOL
AGE CHILD CARE RESERVATION FORM 2018 - 2019 SCHOOL YEAR CENTRAL REGION YMCAS, SERVING SEATTLE
PUBLIC SCHOOL LOCATIONS

CHILD’SINFORMATION

Legal First Name

MI

Legal Last Name

School Attending in the Fall

Date of Birth

Gradein Fall

Gender

MONTHLY CARE OPTIONS

5 DAYS

MONDAY- FRIDAY

3 DAYS

MONDAY,
WEDNESDAY & FRIDAY

2 DAYS

Tuesday &
Thursday

o

After School Care
Extended

·Includes After School Care and Early Release Days until6:00pm

·Does not include Non-Student Days orBreaks

$460per month

$330per
month

$240per month

o

After School Care
Extended PLUS

·Includes After School Care, Early Release Days, Non-Student
Days and Breaks until6:00pm

$510per month

$365per
month

$265per month

YMCA
Youth Membership

Each student enrolled in the YMCA
School Age Child CareProgramat Rainier View Elementary will beprovided with a freeYMCA Youth Membership, which offers
discounts for YMCA programs such as youth sports, swim lessons and summer
camp. FamiliesmayalsoapplythevalueoftheYouthMembershiptowardaFamilyMembership.

Financial Assistance

YMCA Child Care is affordable for all.
We accept State and City subsidy. To determine if you qualify for State DSHS
subsidy, visit www.washingtonconnection.org.
To determine if you quality for City Subsidy, call 206 386 1050 or
email

ccap@seattle.gov.
In
addition, the Y provides financial assistance and a sliding fee schedule to
ensure all families have

access to quality and enriching
programs beyond the bell.

PARENT/GUARDIANCONTACTINFORMATION

Legal First Name

MI

Legal Last Name

Date of Birth

Gender

Email

Phone
Number

ADDITIONAL QUESTION

Do you have any health concerns, allergies, dietary
restrictions or behavior concerns we should be aware of?

DISCLOSURE STATEMENT AND ACKNOWLEDGMENT

The Y Charges an
annual registration fee of $50. This will hold your spot for the 2018/2019
school year program. Our Registrar will contact you for billing information
to complete your enrollment. If the fee presents a challenge, please let our
staff know so we can work on a payment arrangement with you. Families will be
required to complete a Child Care Registration Packet to officially register
their child.

Cancellation
Policy: Must provide two weeks written notice. If payment is already made, we
will issue a partial refund. If payment is not made yet, we will adjust your
upcoming payment based on when the two weeks notice is given.